abruptio placentae [L, ab, away from, rumpere, to rupture] , abnormal separation of a normally implanted intrauterine pregnancy. There are three types: complete (entire placenta separates), partial (part of placenta separates), marginal (separation limited to placental edge). This complication occurs in approximately 0.4%–1% of viable pregnancies. Risk factors include: hypertension including preeclampsia and eclampsia, multiple gestation, smoking, cocaine use, trauma. Previous abruptio placentae increases the risk by fifteenfold to twentyfold. It is the most common cause of coagulopathy in pregnancy. Fetal survival depends on gestational age, degree of placental separation, and timeliness of delivery if required (vaginal or cesarean section). Also called ablatio placentae, placenta abruptio, placental abruption. Compare placenta previa. See also Couvelaire uterus, fetal distress, placenta accreta, postpartum hemorrhage. ▪ OBSERVATIONS: Bleeding from the site of separation causes abdominal pain, uterine tenderness, and tetanic uterine contraction. Bleeding may be concealed within the uterus or may be evident externally, sometimes as sudden massive hemorrhage. In severe cases, shock and death can result in minutes. Partial separation may cause little bleeding and may not interfere with fetal oxygenation. ▪ INTERVENTIONS: If the pregnancy is near term, labor may be permitted or induced by amniotomy. A premature pregnancy may be allowed to continue under close observation of the mother on bed rest. In severe cases, cesarean section must be performed immediately and rapidly. Extensive extravasation of blood within the uterine wall may deplete fibrinogen, prolong clotting time, cause intractable bleeding, lead to disseminated intravascular coagulation, and by damaging the uterine musculature, prevent the uterus from contracting well after delivery. Uterine artery ligation or hysterectomy may be necessary to prevent exsanguination. ▪ PATIENT CARE CONSIDERATIONS: The health care provider must be alert to the possibility that bleeding is present but concealed internally and that if all the blood can escape, there may be little pain.
